Friday, September 07, 2007

Acupuncture and back pain

Many health websites actively promote acupuncture for back pain. I've always considered acupuncture with a doubtful eye, mostly because it is based on unfounded anatomical features, and involves an energy which by its own definition is undetectable by empirical science. One skeptic put it as such:

"The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians."

Yet there are meta-analyzes and even a lancet publication showing that acupuncture does have a modest significant effect over sham needles (but is not superior to standard treatment). This raises questions has to why an effect was observed. One possibility is bias, since the trials are not double-blind, the acupuncture practitioner knows when he is putting the needles in the supposedly real points or when he only inserts them superficially on random places. As such the patient may be consciously or subconsciously influenced to agree with the practitioner's own beliefs, even if he/she is well intentioned. Another possibility is that there is indeed a real effect. For example, inserting the needles in deeper may have elicited more pain signal and allowed the release of more endorphins than the superficial sham needles. I think the only way to truly test if acupuncture works would be to compare the same needles, inserted the same way in a double blinded manner. Someone who was trained on how to insert the needles but not "where" would be given two "maps" and not told which is which. Of course if that would fail to work the alternative medicine practitioners would probably say that it is an unfair comparison and that only they have the holistic energy channeling knowledge. But it would sure satisfy me.

Placebo is most potent in terms of reducing pain, which suffers a large influence from the state of mind. Another hallmark of placebo is that it tends to be most effective acutely and tends to diminish with time, and with repeated treatment. acupuncture seems to satisfy both these conditions.

Anyways all this was to introduce the Traditional Chinese Medicine Act, 2006, which allows tradional chinese healers to be called Doctors and allows them to communicate a diagnosis to a patient based on traditional practices in Ontario. I really do wish western evidence-based medicine and alternative medicine would be treated equally, that is that both would have to prove efficacy and safety in controlled trials. Soon we'll be in the same situation than the UK which has multi-million dollar homeopathetic state-funded hospitals, complete with ambulances.


Anonymous said...

Communicate a diagnosis?!!? For REAL?!?
Think of the abuses. The first time that someone comes up to me and says that they have been diagnosed with some 'energy flow interuption' by a reading of their tea leaves, I'm going to sell them some 'herbal gullible extract' for a ridiculous sum.
L. Ron Hubbard said if you want to make money invent a religion. I say if you want to make money invent a way to diagnose an invented disease and sell and invented cure.

Bayman said...

I'm pretty skeptical of acupuncture too, although I've never tried it. However, the quote you cited raises an interesting point. While one of the biggest criticisms leveled at acupuncture is that it is based on the idea of meridians and such that have no (detectable) basis in the physical world, this doesn't mean it is nonsense per se. The example of geographic meridians shows that conceptual abstractions can be useful to science. Indeed the whole of mathematics is also based upon such abstractions. Perhaps an alien visitor from space would ridicule Western science for the notion of negative quantities, or imaginary numbers - when was the last time you saw evidence for one of these?

Anyway, maybe acupuncture meridians would seem less ridiculous and potentially even useful if thought of as a conceptual guide rather than a concrete physical entity. This still does not mean that acupuncture is in fact legitimate, but that it would be hypocritical for Western scientists whose pursuits are based notions of "imaginary" numbers and the like to dismiss the entire idea simply on the grounds that it uses "unreal" conceptual abstractions.

Ultimately abstractions should be judged on whether they lead us to novel or useful insight.

With regards to the physiological basis for pain relief resulting from acupuncture, I have heard a semi-scientific sounding theory that is plausible, although I have no idea whether there is any evidence in support. The idea was that poking people with needles basically causes a sort of micro-injury that stimulates the release of endorphins and other hormone-type stuff that give temporary pain relief. This might also explain the modest, transient, and diminishing de-sensitization) effects of acupuncture.

As I said, I have no idea whether there is any evidence for this. Interestingly I find that exercise can offer a similar transient relief from chronic pain, and it is well-known that exercise stimulates the release of endorphins and other feel-good type hormones.